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End of Life Care: Should I be an organ donor?

It’s hard to ignore the national campaign to encourage organ donation. You encounter it on bumperstickers and billboards, and you deal with it when you renew your driver’s license at the Department of Motor Vehicles.

With all of the hype surrounding organ donation, it’s easy to ignore the specifics surrounding the procedure. How are the organs obtained? How is death declared for those who are potential organ donors? Are any organs or tissues suitable for transplantation after the death of the donor?

These major questions require detailed answers before you make a decision to be an organ donor. Take a few minutes now to learn some important facts before placing that “Organ Donor” sticker on the back of your driver’s license.


Widespread attention to organ donation can be traced to Dr. Christiaan Barnard’s heart transplant in South Africa in 1967. This was followed quickly by the 1968 publication in the Journal of the American Medical Association of the Harvard Criteria, which allowed “brain dead” patients to become unpaired vital organ donors.

According to the United Network for Organ Sharing (UNOS), a total of 20,260 transplants were performed in 1996. At the same time, UNOS claims approximately 70,000 people in the United States were on transplant waiting lists. Given these figures, UNOS and other organizations have issued a call for increased public awareness on the “shortage of organs” and a national campaign to “enhance public support of organ donation.”(1)

Who is the “organ donor”?

People can specify their wish to have their organs transplanted by signing a Uniform Organ Donor Card or by placing an “organ donor” sticker or checking a box on the back of their driver’s license.(2) Since the vast majority of Americans do not take these steps, organ harvesting is often completed after the patient has been declared “dead” and the family makes the decision.

According to UNOS, “Donors are people in good health who have died suddenly–possibly through accidents–and have been declared ‘brain dead.’” UNOS says that “[i]n this condition, brain function is permanently ceased, but the heart and lungs continue to function . . .”(3) Organs can be harvested from anyone–from newborns to senior citizens. The “donor’s” health, however, is an important factor in the transplantation decision.

Are the patients really dead at the time of organ harvesting?

Organ transplantation is linked to the notion of “brain death.” As a matter of fact, supporters of “brain death” as a criterion for declaring a patient dead readily admit that one of its main purposes is to aid in the harvesting of organs. In 1997, the “brain death” debate in Japan focused exclusively on the need for adopting this criterion into law in order to advance the harvesting of organs there. One major newspaper editorialized against “brain death” asking, “Could you accept that a loved one is dead, even if the heart still beats and cheeks are flush?”(4) Still, the bill passed and is now law.

Before “brain death” was initiated in 1968, it was legally and ethically difficult, and practically impossible, to harvest unpaired vital organs such as the heart. The traditional criterion for declaring death centers on absence of breathing, heartbeat and brain function. Although some tissues can be harvested after death declared under the traditional criterion, hearts can be harvested in good condition for transplant only while there are functioning circulatory and respiratory systems, which exist when a person has been declared “brain dead.”(5) This is necessary because blood must be pumping in and out of the heart and the respiratory system must be transporting oxygen to the heart. If this does not happen, destruction of the heart will occur.

Under the “brain death” criterion, the patient is declared “brain dead” while his or her vital organs are still functioning. The patient is paralyzed but not given anything for pain. An incision is then made, and the beating heart and other organs are removed for harvesting.

While some say that the “brain dead” patient is truly dead, a variety of evidence calls into question the entire notion of “brain death.” Scholars and physicians admit that “brain death” is conceptually and practically flawed.(6)

Can anything be donated without harming me or ending my life prematurely?

While living, a person may give charitably one of his or her paired vital organs (such as a kidney) and non-vital tissues to someone else. In fact, “living donor” kidney transplants are becoming more common each year.(7) Such donations, however, must be done cautiously to protect the life and health of the donor. The donation must be specifically for the benefit of the life or health of the recipient person and not solely for scientific purposes. After death, some non-vital tissues–such as corneas, heart valves, bone, skin and connective tissues–may still be useful for transplant.(8) The donor, or someone who legitimately represents the donor, must give prior, explicit, free and conscious consent. The donor’s care and treatment must not be altered in any way to the possible detriment of his/her life or health for the purpose of better preserving organs or tissue for donation before or after death.

The concept of organ transplantation is a noble one, but as the campaign to promote organ “donation” grows in intensity it is imperative to look closely at the facts. As patients are declared “brain dead” and their organs are removed while vital bodily functions continue, serious questions and concerns arise. Is the donor really dead? More and more ethicists and physicians are taking a new look at the notion of “brain death” and its deadly ramifications. Even so, efforts to increase the supply of vital organs for transplant continue to expand in ethically and morally questionable ways. Attempts have been made to take vital organs from babies born with an abnormality of the brain known as anencephaly and from others who do not fulfill even the flawed “brain death” criterion.

Everyone has the right to know all the facts surrounding organ transplantation. Unfortunately, the average person does not and will not know the details of this life and death issue. However, with the serious ethical and moral questions surrounding organ harvesting, people would be wise to think long and hard before joining the organ donation campaign.

More to the point, we must remember that it is never right, even for the most serious reasons, to do evil that good may come of it.(9) Noble though the concept of organ donation may be, it does not justify sending the donor to a premature grave.


(1) United Network for Organ Sharing (UNOS, 1100 Boulders Pkwy., Suite 500, Richmond, VA 23225) Press Release, April 18, 1997.

(2) “Facts About Organ Donation and Transplantation,” UNOS.

(3) Ibid.

(4) Jordan, Mary, “Brain-Death Bill Passes Easily in Japanese House,” The Washington Post, April 25, 1997.

(5) Cf. “Facts About Organ Donation and Transplantation,” UNOS.

(6) See Jones, David Albert, “Nagging Doubts About Brain-Death,” CMQ, February 1995; Shewmon, Alan, “Recovery from ‘Brain Death’: A Neurologist’s Apologia,” Linacre Quarterly, February 1997, pages 62-75; Truog, Robert, “Is it Time to Abandon Brain Death?” Hastings Center Report, Vol. 27(1), January-February 1997, pages 29-31. See also When is a Person Really Dead? American Life League, 1998.

(7) UNOS Press Release, April 18, 1997.

(8) See Byrne, Paul, et al., Life, Life Support, and Death: Principles, Guidelines, Policies and Procedures for Making Decisions That Respect Life, American Life League, 1996.

(9) Cf. Romans 3:8.